1986-461 BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-461
WARREN COUNTY, NEW YORK
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PERMISSION is herebygranted to�
James Burnham
OWNER of property located at 1O /Seward Avenue Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage Alteration 5
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is 5 Seward Ave.
Glens Falls,New York
2. CONTRACTOR or BUILDER'S Name
Andy Scarpellino
3. CONTRACTOR or BUILDER'S Address SEward Ave.
Glens Falls, New York
4. ARCHITECT'S Name
U,
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) •
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. 1000 gallon tank, and two 5'x7' seepage pits per plot
and application
to
8. Proposed Use
Sewage system for dwelling
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES July 30 19 88 rt
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the H.
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 30th Day of July 19 86
SIGNED BY )/1 het, 6.. x.! for the Town of Queensbury
Building and Zoning Inspector c
TOWN OF QUEENS. : , .
-own of Queenilury APPLICATION FOR SEPTIC RSPIL.EPPVI
y BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98 RI 198
Queensbury, New York 12801 _ 'DATE /O� (5 1.J��� AI&M.
," 21819034;2m40 .
LOCATION OF PROPERTY FOR INSTALLATION \r) Seeanro I I . ,
•
OWNER'S NAME �' / c'r-1� , gtilV 0 A q Jti,
ADDRESS g SC GO rJ TEL I (9Th:2193 R
•
INSTALLER' S NAME / fe��, ,e// t ` . TEL 7V—cf-// (®
Number of bedrooms(residential only) ..
Total daily flow(compute @ 150 gal per bedroom) (30 C :' . -
Topography:410D- Rolling - Steep- slope -(circle one) % of slope
Soil nature: Sand - Loam - Clay - Other Depth ft.
Ground water -At what depth? /® ft.
A.
Bed-rook or impervious material - At. what depth? /01-)* ft. .
Percolation test -hot required) Required - -Rate min-inch.
Domestic water supply Municipal _ Well - Other
•
Separation - .Watersupply(if well) from Septic absorption 4J/4 ft.
Proposed System: Septic tank ) 0 0 a gal. ( Minimun size, 1000 gal. )
Tile Field - Each trench A/ht ft. Total syste legnth ft.
Seepage pit(s) Number of ' v` Size each - ft X 7 ft •
Size of stone to be used # ' .P ' Depth or thickness G • ft.
IMPORTANT! !
On a separate piece of paper, submit a diagram of the proposed system
with all dimensions shown; including distance from any structure, •
distance from property lines and from ANY DOMESTIC WATER SUPPLY or
shore-line of lake, stream,pond .or wet-lands. 'Include all dimensions of
the system, itself.
* •* * * * * * * * *• * * * * * * * * * * * * * * * * * * * * * * * * * * *
I .have read the regulations on the reverse side of this sheet and agree
to abide by these and aZZ requirements of The Town of Queensbury
Sanitary Sewage Disposal Ordinance. .
Signature ofresponsible person 9 P P /v im.-,; i /._�. _
j0,42__
Date —/„tJ/tf/?
- rV
05/86 and/vl
•
•
Section II Septic System Inspections:
A,. All applications for septih system installation,
alteration or repair, as required by the Town of
Queensbury Sanitary Sewage. Ordinance, shall be
submitted to the Building- Department -at least
24 hours before start of construction .and shall
include a plot planshowing:
1) ' the proposed location of the system.
• 2) location and distance to lot lines
3) location and distance to structures
4) location and distance to any water supply
5) size and dimensions of all tanks, distribution
• boxes, tile fields and/or drywells
B. No system shall be covered before inspection and '
approval by the Building Inspector. Failure to •
comply with this requirement may result in the
• uncovering of the system by the ,installer and a
fine of up to $250. 00. •
• C. An approved -copy of the plot plan shall be
available on the construction site. . Failure
to produce said plot plan at time of inspection
may result in an immediate work stoppage.
D. Should unforeseen problems during construction
prevent proper installation, alteration or
repair of an approved system, - a new proposal
must be submitted to the Queensbury Building
• Department before further construction .
Jocun of Queen iur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME S�+?ea..A.--VAL IAA
LOCATION 7 Sel k t9 +
DATE / r PERMIT NO. )i, " 4c /
SOIL TYPE - 0- Loam - Clay .
Percolation Test Required? YES - .NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS{Number of) •
Size- 5'ft. X 7 ft. •
Gravel size
PIPING: Size Type
Bldg. to tank 41 ' Sejt.1/r�
Tank to dist. box " 'Z7/3
Dist. box to field/• ' // Z7/3 •
Openings sealed? CO NO Partial
LOCATION/SEPARATIONS: j
Foundation to tank Z-$ ft.
Foundation to absorption ZIs eft.
Absorption to lot line g2-ft.
Separation of pits JAL/ft.
LOCATION .104..YSTEM ON PROPERTY(circle one)
Front -ON Left side - Right side -
COMMENTS:
P-1/TLLk.
.1 ,nti
45'
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TA-11--Ct P;k
•
SYSTEM USE APPROVED Y S NO
B 11 ing4nspector
01/86 and vl •
\ al,T
Down of Queenibur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SSEPTIC DISPOSAL SYSTEM INSPECTION
NAME CAA Ac.nl- I?/`1\
LOCATION ,—aufV11\tC
DATE��) /Sb PERMIT NO. S In —9-�
SOIL TYPEY - Sand - Loam - Clay
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS4Number of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box _
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENT J
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\19.6:46WL -'4'Nt 1/1A C6\i' fLA.
GLY.6-ZIJC-+'
Cat3 ILA 6 tiUrL
SYSTEM USE APPROVED Y' NO
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